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Situation Report #39 on Cholera in South Sudan As at 23:59 Hours, 30 July 2015

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Situation Report #39 on Cholera in South Sudan As at 23:59 Hours, 30 July 2015 Republic of South Sudan Situation Report #39 on Cholera in South Sudan As at 23:59 Hours, 30 July 2015 Situation Update As of 30 July 2015, a total of 1,383 cholera cases including 42 deaths (CFR 3.04%) have been reported in Juba and Bor Counties in Central Equatoria and Jonglei States respectively. In Juba County, 1,268 cases including 41 deaths (CFR 3.23%) have been reported from seven Payams (Table 1). In Bor, 115 cases including one death (CFR 0.87%) have been reported from Malou in Makuach Payam and other areas within the County. The initial cases in Juba were traced back to 18 May 2015 in UN House PoC where the first cholera case was confirmed on 1 June 2015. The most affected Payams in Juba County are Kator, Rejaf, Northern Bari, and Munuki that have registered attack rates (cases per 10,000) of 200, 191, 139, and 25 respectively (Annex 1). In Bor, the initial cases were reported from Malou in Makuach Payam. Makuach Payam is the most affected in Bor and has registered an attack rate (cases per 10,000) of 30 (Annex 1 and 2). Table 1. Summary of cholera cases reported in Juba and Bor Counties, 18 May – 30 July 2015 Reporting Sites New New New Total cases LAMA* Total Total Total Total cases Total cases admisions discharges deaths currently facility community deaths discharged admitted deaths deaths CES – Juba County 8 12 0 34 205 25 16 41 988 1268 IMC UN House PoC clinic 0 0 0 0 0 0 1 1 71 72 Juba Teaching Hospital 4 8 0 30 201 21 7 28 698 957 MedAir Gumbo CTU 0 0 0 1 0 1 0 1 74 76 MedAir Gudele ORP 0 0 0 0 0 0 0 0 8 8 HLSS Nyakuron ORP 1 1 0 0 0 0 0 0 22 22 HLSS Kator ORP 0 0 0 0 0 0 0 0 6 6 HLSS Gurei ORP 0 0 0 0 0 0 0 0 34 34 HLSS Munuki ORP 0 0 0 0 0 0 0 0 3 3 HLSS Al Sabah ORP 1 1 0 0 0 1 0 1 9 10 HLSS Lologo ORP 0 0 0 0 0 0 0 0 8 8 MSF Munuki CTC 2 2 0 3 4 0 0 0 37 44 Other sites in Juba 0 0 0 0 0 2 8 10 18 28 Jonglei State – Bor 0 1 0 0 3 1 0 1 111 115 Bor State Hospital 0 1 0 0 3 1 0 1 111 115 Total 8 13 0 34 208 26 16 42 1099 §1383 *LAMA: LEAVE AGAINST MEDICAL ADVICE; CES- Central Equatoria State; § Following data cleaning, 56 duplicate records were deleted from the database. A total of eight new cholera cases were reported in Juba on 30 July 2015 (Table 1 and Figure 1). o Eight new cases were reported from Juba County, with the majority originating from Mia Sava in Munuki Payam. o There was no new case reported from Bor on 30 July 2015. Figure 1: New cholera cases by residence on 30 July 2015 3 2 1 2 1 1 1 1 1 1 0 Mia Sava Nyakuron PRRS Dar Salam Jebel Lemunigaba Kodoro Number casesofNumber West Checkpoint Munuki Northern Bari Rejaf Juba 1 During week 31 of 2015 (week of 30 July 2015), most of the cholera cases in Juba originated from Kor William and Lologo in Kator; Jebel Dinka, Lokuilili, and Hai Baraka in Northern Bari; Hai Jebel, Nyakuron west, and Mia sava in Munuki; and Gumbo in Rejaf (Figure 1.1). During week 31 of 2015, the most affected Payams in Juba County were Kator, Northern Bari, Rejaf and Munuki that registered attack rates (cases per 10,000) of 10, 8.2, 5.6, and 1.2 respectively (Annex 1). Figure 1.1: New cholera cases by residence during week 31 of 2015 6 5 s 4 e s a c f o r 3 e b m 5 u N 2 4 3 3 3 1 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 i l l i i i i t t t f r r t r k S l i a a a a e e 5 1 a n o o o C o a a a B r r k i g a s e e e m m a a a t a a n t u r l k k y u d k g i R b n d n a b j d t r i i i u j i v t r u k n e w b b k o a a b o l S i k g n n a a n i l o L S o a R n e S b u o u o r a c u a u a i i l g e e l i o r l g m i r l d g u l p u n a s o a a a P J J R W k p K o i i i G k o o d a D D p h n u e l G o g S o w k Z l M B n i M k l o N L n a h u l l i S B a n M b B b i e n K i a G o r c o u L W e c k a S w u e e L i e o i a e L o a y o a e N H b r r u b e J A r a J b b M M e b T n m h H D e u o o r u u e e N H J u o e J C J J S K k u J G i L l K a e G e y r b u N e G J Juba Kator Munuki Northern Bari Rejaf MakuWaochn glei Juba Bor Cumulatively, 1,383 cholera cases including 42 deaths (26 facility and 16 community) have been reported in Juba and Bor Counties since the initial case was reported on 26 May 2015 in Juba (Tables 1 and 2). Of the 42 deaths, nine (21%) occurred in children under five years while 27 (64%) occurred in males. In Juba County, Juba Payam has registered the highest CFR followed by Northern Bari, Rejaf, Munuki and Kator (Annex1). Table 2: New cholera cases by facility and week in Juba and Bor Counties, 18 May – 30 July 2015 New cases by epidemiological week of 2015 Reporting Facility 21 22 23 24 25 26 27 28 29 30 31 Grand Total CES – Juba County 4 2 7 56 130 229 235 161 237 150 57 1268 JTH 0 2 2 32 119 208 207 116 146 93 32 957 Juba 3 IMC clinic 4 0 4 9 6 13 10 10 11 5 72 HLSS Nyakuron ORP 0 0 0 0 0 0 2 3 11 2 4 22 HLSS Kator ORP 0 0 0 0 0 0 0 3 1 2 6 MedAir Gudele ORP 0 0 0 0 0 0 0 4 3 1 8 MedAir Gumbo CTU 0 0 0 0 0 5 15 20 25 10 1 76 HLSS Gurei ORP 0 0 0 0 0 0 0 1 11 10 12 34 HLSS Munuki ORP 0 0 0 0 0 0 0 1 0 2 3 HLSS Al Shabah ORP 0 0 0 0 0 0 0 0 4 3 3 10 HLSS Lologo ORP 0 0 0 0 0 0 0 0 2 4 2 8 MSF Munuki CTC 0 0 0 0 0 0 0 0 23 18 3 44 Other sites in Juba 0 0 1 15 5 3 1 3 0 0 28 Jonglei State – Bor County 0 0 0 0 0 5 46 33 21 8 2 115 Bor State Hospital 0 0 0 0 0 5 46 33 21 8 2 115 Grand Total 4 2 7 56 130 234 281 194 258 158 59 1383 As seen from Figure 2, the initial and isolated cases were reported from UN House PoC in Juba starting on 26 May 2015. However, following epidemiological investigations on 27 May 2015, cases could be traced back to 18 May 2015. Cholera was eventually confirmed on 1 June 2015 in Juba after Vibrio cholerae inaba was isolated from the one of five samples tested in the National Public Health Laboratory. Since 6 June 2015, sustained and consistently increasing community transmission was established in Juba with increasingly more suspect cases reported outside UN House PoC. There are four transmission peaks with the initial peak of 15 cases occurring on 13 June 2015 while the subsequent and higher peaks occurred on 20 June, and 26 June before reaching the second highest peak on 28 June. Since then, successively shorter transmission peaks were registered. This trend was largely driven by sustained community transmission in Juba, Northern Bari, Rejaf, Munuki, and Kator Payams (Annex 2). On 19 July 2015, a total of 2 61 new cases in Juba County were linked to a funeral in Atlabara B, thus resulting into the highest peak during the outbreak.
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